AmAMP1 from Acropora millepora and damicornin define a family of coral-specific antimicrobial peptides related to the Shk toxins of sea anemones

A candidate antimicrobial peptide (AmAMP1) was identified by searching the whole genome sequence of Acropora millepora for short (<125AA) cysteine-rich predicted proteins with an N-terminal signal peptide but lacking clear homologs in the SwissProt database. It resembled but was not closely related to damicornin, the only other known AMP from a coral, and was shown to be active against both Gram-negative and Gram-positive bacteria. These proteins define a family of AMPs present in corals and their close relatives, the Corallimorpharia, and are synthesised as preproproteins in which the C-terminal mature peptide contains a conserved arrangement of six cysteine residues. Consistent with the idea of a common origin for AMPs and toxins, this Cys motif is shared between the coral AMPs and the Shk neurotoxins of sea anemones. AmAMP1 is expressed at late stages of coral development, in ectodermal cells that resemble the "ganglion neurons" of Hydra, in which it has recently been demonstrated that a distinct AMP known as NDA-1 is expressed.

Patients' experiences of Parkinson's disease: a qualitative study in glucocerebrosidase and idiopathic Parkinson's disease

BACKGROUND

Approximately 7-10% of Parkinson's disease (PD) patients carry a GBA (Glucocerebrosidase) mutation (GBA-PD patients), which may influence the disease's clinical course.

OBJECTIVES

This study aimed to explore the patient experience of GBA-PD and identify the most important symptoms and impacts to inform clinical trial measurement strategies.

METHODS

Twenty PD patients (n = 15 GBA-PD; n = 5 idiopathic-PD) participated in qualitative interviews which explored concepts spontaneously reported or identified through a literature review. Telephone interviews with five expert clinicians included discussion of a preliminary conceptual model derived from literature. Verbatim transcripts were thematically analysed.

RESULTS

Thirty symptoms reported by patients were categorized as motor, non-motor, and cognitive/psychiatric. Tremor (n = 13), memory loss (n = 13), rigidity/stiffness (n = 11), and speech problems (n = 11) were considered the most important and impactful symptoms by GBA-PD patients, although other symptoms were also relevant to the majority of patients. Key impacts included: sleep disturbances (n = 13), handwriting changes (n = 13), reduced social interaction (n = 12), dyskinesia (n = 10), depressed mood (n = 9), and fear of falling (n = 8). Key symptoms and impacts reported by GBA-PD patients were consistent with those reported by idiopathic-PD patients. Clinician interview results supported the patient findings, although some clinicians indicated that cognitive/psychiatric symptoms may present earlier in GBA-PD patients. The concepts emerging from the research informed updates to a conceptual model of GBA-PD patients' disease experience.

CONCLUSIONS

The findings provide in-depth understanding of the patient experience of GBA-PD. The findings confirm that the concepts relevant to assess in GBA-PD are consistent with those relevant to assess in idiopathic-PD; however, greater consideration of cognitive/psychiatric symptoms may be warranted in GBA-PD populations.

1095 Use Of Mobile Devices At Night Associated With Mental Health In Young Adults

Introduction

Mobile technology use in bed is becoming commonplace and associated with habitual short sleep duration. The present study examined whether device use at night was related to mental health.

Methods

Data from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study comes from a community-based sample, which was restricted to N=473 between the ages of 22-29. Device use was assessed as presence in the room at night, any use at night, texting, emailing, browsing the internet, making or receiving calls, and using social media. Participants were also asked how often they are woken by a call/alert from their phone (unplanned), how often they are woken by their phone alarm (planned), and how often they check their phone at night. These were recorded as never, rarely, some nights, almost every night, and every night, and were assessed as an ordinal outcome. Predictors included score on the Patient Health Questionnaire depression scale (PHQ9), GAD7 anxiety scale, Perceived Stress Scale (PSS), and Multidimensional Scale of Perceived Social Support (MSPSS). Ordinal logistic regression analyses were adjusted for age, sex, race/ethnicity, education, and income.

Results

Depression was associated with texting (oOR=1.03, p=0.025), email (oOR=1.03, p=0.022), internet (oOR=1.05, p=0.003), unplanned awakenings (oOR=1.05, p=0.001), and checking the phone (oOR=1.09, p&lt;0.0005). Anxiety was associated with texting (oOR=1.05, p=0.001), email (oOR=1.05, p=0.001), internet (oOR=1.05, p=0.002), social media (oOR=1.04, p=0.009), unplanned awakenings (oOR=1.06, p&lt;0.0005), planned awakenings (oOR=1.04, p=0.025), and checking the phone (oOR=1.10, p&lt;0.0005). Perceived stress was associated with internet (oOR=1.02, p=0.034), unplanned awakenings (oOR=1.02, p=0.045), and checking (oOR=1.04, p&lt;0.0005). Social support was associated with decreased checking (oOR=0.98, p=0.018).

Conclusion

Mobile device use at night itself is not associated with mental health, but specific activities may be. Also, those who report more disruptions from the device and more checking of the device also report worse mental health. Relationships might be bidirectional.

Support

Dr. Grandner is supported by R01MD011600

The SHADES study was funded by R21ES022931

Control of a community outbreak of hepatitis A in an area of low endemicity, Wales, 2016

Incidence of hepatitis A in Wales is low (average of 0.48/100,000 inhabitants from 2004-2015). We describe a community outbreak of hepatitis A involving 3 schools (primary and secondary) in South Wales between March and June 2016 and reflect on the adequacy of the control measures used. Anyone in South Wales epidemiologically linked to a serological and/or RNA positive confirmed case of hepatitis A during the 15-50 d before onset of symptoms (diarrhea, vomiting, fever, nausea, AND jaundice, or jaundice-associated symptom) was defined as a case. Case identification was based on laboratory or GP suspicion notification, changing to active surveillance toward the end. As per national guidance, household contacts were identified and offered immunisation while in schools vaccination followed evidence of transmission. We went beyond guidance by vaccinating street play mates and in secondary schools. Mass vaccination uptake was calculated. There were 17 cases, mostly in children under 16 y of age. All cases had an epidemiological link to either a school or a household case (except primary) and no travel history. Street playing was the only epidemiological link between 2 cases in different schools. A total of 139 household contacts were identified. All schools, including secondary one, had a transmission event preceding mass vaccination (overall uptake 85%, reaching 1,574 individuals) and no tertiary cases emerged after the campaigns. We recommend extending guidance to include actions taken that helped curb this outbreak: 1) vaccinating in secondary school and 2) broadening the household contact definition. Based on our learning we further suggest 3) vaccinating upon identification of a single case who attended school while infectious regardless of source and 4) active case finding by serologically testing contacts.

A pilot study of an HbA1c chairside screening protocol for diabetes in patients with chronic periodontitis: the dental hygienist's role

OBJECTIVE

To assess effectiveness, convenience and cost of point-of-care diabetes screenings performed by a dental hygienist for patients with periodontitis, using a diabetes risk questionnaire, periodontal findings and a glycosylated haemoglobin (HbA1c) analyser.

METHODS

A purposive sample of 50 participants with periodontitis, never diagnosed with diabetes, reporting ≥one diabetes risk factor, were administered an HbA1c test. Spearman's correlation measured relationships between HbA1c and diabetes risk test scores, numbers of missing teeth, percentage of deep pockets ≥5 mm and percentage of bleeding sites (BOP). Cost and time were assessed. Analyses used 0.05 alpha levels.

RESULTS

Thirty-two per cent (n = 16) of participants presented HbA1c values indicating prediabetes; one HbA1c value indicated type 2 diabetes, totalling 34% (N = 17). No relationships existed between HbA1c values and diabetes risk scores (rs = 0.153; P = 0.144), numbers of missing teeth (r = 0.190; P = 0.093), percentage of deep pockets (rs = -0.048; P = 0.370) or percentage of BOP sites (rs = 0.066, P = 0.324). Direct cost for each HbA1c was $9US, excluding follow-up medical diagnosis. Mean screening time including patient education was 14 min (SD = 6.2). Fifty-three per cent (n = 9 of 17) of participants with elevated HbA1c values contacted their primary healthcare provider within 2 weeks as recommended.

CONCLUSION

Point-of-care HbA1c screenings by dental hygienists were effective and convenient for identifying undiagnosed prediabetes and provide opportunity for interprofessional patient care; cost or lack of dental insurance may inhibit implementation. Identification of patients at risk for diabetes requires further evaluation.

Bone density in healthy men after cessation of calcium supplements: 20-month follow-up of a randomized controlled trial

Bone density has been followed up for 20 months following completion of a trial which compared calcium 1,200 mg/day with placebo, in normal older men. Following cessation of calcium supplements, there is a small residual benefit in total body bone density, but not at the hip or spine.

INTRODUCTION

Calcium supplements, or supplements of calcium-rich foods, have a positive effect on bone mineral density (BMD). However, it is uncertain whether there are any residual benefits of calcium on BMD following cessation of supplementation.

METHODS

In a previously published study, 323 healthy men were randomized to receive elemental calcium 600 mg/day (n = 108), calcium 1,200 mg/day (n = 108), or placebo (n = 107) over 2 years. Consenting men from the placebo and calcium 1,200 mg/day groups (85 and 87, respectively) were followed over the next 1-2 years (mean 20 months), off trial medication.

RESULTS

In the core trial, BMD increased at all sites by 1.0-1.5% at 2 years in the group receiving calcium 1,200 mg/day, compared to the group receiving placebo. In post-trial follow-up, the calcium group has some residual benefit at the total body (0.41% above placebo; P = 0.04) but there was no significant between-group differences at other sites.

CONCLUSION

Following cessation of calcium supplements in healthy men, there is a small residual benefit in total body BMD, but not at the hip or spine. This is unlikely to confer a clinically significant dividend in terms of ongoing fracture prevention.

The Auckland calcium study: 5-year post-trial follow-up

Five years after completion of a randomised placebo-controlled trial of calcium supplements, there was no effect of calcium on total fracture incidence, a significant reduction in vertebral and forearm fractures and, in a subset, no effect on bone density. There was no increased risk of cardiovascular events after discontinuation of calcium.

INTRODUCTION

The Auckland calcium study was a 5-year randomised controlled trial of 1 g/day calcium citrate in 1,471 postmenopausal women. Calcium did not reduce total, vertebral or forearm fracture incidence, increased hip fracture incidence and had beneficial effects on bone mineral density (BMD). A secondary analysis raised concerns about the cardiovascular safety of calcium. The purpose of this study was to determine whether the effects of calcium on fracture incidence, BMD and cardiovascular endpoints persisted after supplement discontinuation.

METHODS

Approximately 5-years post-trial, we collected information on the 1,408 participants alive at trial completion from the national databases of hospital admissions and deaths. We contacted 1,174 women by phone, and from these we obtained information on medical events and post-trial calcium use. We undertook BMD measurements at 10 years in a selected subset of 194 women who took study medication for 5 years in the original trial, and did not take bone-active medications post-trial.

RESULTS

Over the 10-year period, there was no effect on total fracture (HR 0.90, 95% CI 0.75-1.07) or hip fracture incidence (1.40, 0.89-2.21), but significant reductions in forearm (0.62, 0.43-0.89) and vertebral fractures (0.52, 0.32-0.85) in those assigned to calcium. There were no between-group differences in BMD at 10 years at any site. The adverse cardiovascular outcomes observed in the 5-year trial did not persist post-trial.

CONCLUSION

Calcium supplementation for 5 years had no effect on total fracture incidence at 10 years. The positive benefits on BMD and the adverse cardiovascular effects did not persist once supplements were stopped.

Fitness to fly testing in term and ex-preterm babies without bronchopulmonary dysplasia

BACKGROUND

During air flight, cabin pressurisation produces an effective fraction of inspired oxygen (FiO(2)) of 0.15. This can cause hypoxia in predisposed individuals, including infants with bronchopulmonary dysplasia (BPD), but the effect on ex-preterm babies without BPD was uncertain. The consequences of feeding a baby during the hypoxia challenge were also unknown.

METHODS

Ex-preterm (without BPD) and term infants had fitness to fly tests (including a period of feeding) at 3 or 6 months corrected gestational age (CGA) in a body plethysmograph with an FiO(2) of 0.15 for 20 min. A 'failed' test was defined as oxygen saturation (SpO(2)) <90% for at least 2 min.

RESULTS

41 term and 30 ex-preterm babies (mean gestational age 39.8 and 33.1 weeks, respectively) exhibited a significant median drop in SpO(2) (median -6%, p<0.0001); there was no difference between term versus ex-preterm babies, or 3 versus 6 months. Two term (5%) and two ex-preterm (7%) babies failed the challenge. The SpO(2) dropped further during feeding (median -4% in term and -2% in ex-preterm, p<0.0001), with transient desaturation (up to 30 s) <90% seen in 8/36 (22%) term and 9/28 (32%) ex-preterm infants; the ex-preterm babies desaturated more quickly (median 1 vs 3 min, p=0.002).

CONCLUSIONS

Ex-preterm babies without BPD and who are at least 3 months CGA do not appear to be a particularly at-risk group for air travel, and routine preflight testing is not indicated. Feeding babies in an FiO(2) of 0.15 leads to a further fall in SpO(2), which is significant but transient.

The effects of rear-wheel camber on maximal effort mobility performance in wheelchair athletes

This study examined the effect of rear-wheel camber on maximal effort wheelchair mobility performance. 14 highly trained wheelchair court sport athletes performed a battery of field tests in 4 standardised camber settings (15°, 18°, 20°, 24°) with performance analysed using a velocometer. 20 m sprint times reduced in 18° (5.89±0.47 s, P=0.011) and 20° camber (5.93±0.47 s, P=0.030) compared with 24° (6.05±0.45 s). Large effect sizes revealed that 18° camber enabled greater acceleration over the first 2 (r=0.53, 95% CI=0.004 to 0.239) and 3 (r=0.59, 95% CI=0.017 to 0.170) pushes compared with 24°. Linear mobility times significantly improved (P≤0.05) in 15° (16.08±0.84 s), 18° (16.06±0.97 s) and 20° (16.22±0.84 s) camber compared with 24° (16.62±1.10 s). Although no statistically significant main effect of camber was revealed, large effect sizes (r=0.72, 95% CI=0.066 to 0.250) demonstrated that 18° camber reduced times taken to perform the manoeuvrability drill compared with 15°. It was concluded that 18° camber was the best performing setting investigated given its superior performance for both linear and non-linear aspects of mobility, whereas 24° camber impaired linear performance. This was likely to be due to the greater drag forces experienced. Subsequently, athletes would be recommended to avoid 24° camber and young or inexperienced athletes in particular may benefit from selecting 18° as a starting point due to its favourable performance for all aspects of mobility performance in the current study.

Penetration of meropenem into epithelial lining fluid of patients with ventilator-associated pneumonia

Antibiotic penetration to the infection site is critical for obtaining a good clinical outcome in patients with ventilator-associated pneumonia (VAP). Surprisingly few studies have quantified the penetration of β-lactam agents into the lung, as measured by the ratio of area under the concentration-time curve (AUC) in epithelial lining fluid (ELF) to AUC in plasma (AUC(ELF)/AUC(plasma) ratio). These have typically involved noninfected patients. This study examines the penetration and pharmacodynamics of meropenem in the ELF among patients with VAP. Meropenem plasma and ELF concentration-time data were obtained from patients in a multicenter clinical trial. Concentration-time profiles in plasma and ELF were simultaneously modeled using a three-compartment model with zero-order infusion and first-order elimination and transfer (big nonparametric adaptive grid [BigNPAG]). A Monte Carlo simulation was performed to estimate the range of ELF/plasma penetration ratios one would expect to observe in patients with VAP, as measured by the AUC(ELF)/AUC(plasma) ratio. The range of AUC(ELF)/AUC(plasma) penetration ratios predicted by the Monte Carlo simulation was large. The 10th percentile of lung penetration was 3.7%, while the 90th percentile of penetration was 178%. The variability of ELF penetration is such that if relatively high ELF exposure targets are required to attain multilog kill or resistance suppression for bacteria like Pseudomonas aeruginosa, then even receiving the largest licensed dose of meropenem with an optimal prolonged infusion may not result in target attainment for a substantial fraction of the population.

Long-term Cryptosporidium typing reveals the aetiology and species-specific epidemiology of human cryptosporidiosis in England and Wales, 2000 to 2003

To improve understanding of the aetiology and epidemiology of human cryptosporidiosis, over 8,000 Cryptosporidium isolates were submitted for typing to the species level over a four year period. The majority were either Cryptosporidium parvum (45.9%) or Cryptosporidium hominis (49.2%). Dual infection occurred in 40 (0.5%) cases and six other known Cryptosporidium species or genotypes were found in 67 (0.9%) cases. These were Cryptosporidium meleagridis, Cryptosporidium felis, Cryptosporidium canis, and the Cryptosporidium cervine, horse and skunk genotypes. The remaining 3.5% were not typable. Epidemiology differed between infecting species. C. parvum cases were younger, although C. hominis was more prevalent in infants under one year and in females aged 15 to 44 years. Spring peaks in cases reported to national surveillance were due to C. parvum, while C. hominis was more prevalent during the late summer and early autumn as well as in patients reporting recent foreign travel. Temporal and geographical differences were observed and a decline in C. parvum cases persisted from 2001. Typing of isolates allowed outbreaks to be more clearly delineated, and demonstrated anthroponotic spread of C. parvum as well as C. hominis. Our findings suggest that national surveillance for Cryptosporidium should be conducted at the species level.

A multi-country outbreak of Salmonella Agona, February - August 2008

An outbreak of gastroenteritis affecting residents in the United Kingdom, Ireland and Finland is currently being investigated. As of Wednesday 13 August, a total of 119 cases have been identified. An investigation that includes interviews of persons with Salmonella Agona infections, comparison of pulsed field gel electrophoresis (PFGE) profiles of S. Agona isolates from cases and also food samples from an Irish food production company and retail outlet chain supplied by the company, suggests that food products from that company may be related to some of these cases. A number of food products including beef steak strips, chicken in various forms, bacon in various forms, and pork have been withdrawn (see: http://www.fsai.ie/ for details). The investigation is ongoing.

Reducing variation in antibacterial prescribing rates for ‘cough/cold’ and sore throat between 1993 and 2001: Regional analyses using the general practice research database

OBJECTIVE

To use the General Practice Research Database (GPRD) to explore the regional variation in prescribing for single diagnostic episodes of 'cough/cold' and sore throat and how this changed between 1993 and 2001.

METHODS

Data from the GPRD was used to conduct a longitudinal survey of morbidity and antibiotic prescribing data.

RESULTS

Nationally there has been a substantial reduction in diagnosed episodes per 1000 patient years at risk for both diagnoses: from 104.6 (104.0-105.2) to 86.5 (86.0-86.9) for cough/cold (-17.3%) and from 102.8 (102.2-103.4) to 69.2 (68.8-69.6) for sore throat (-32.6%). In addition to the changes in diagnostic rate there have been reductions in diagnosis-related prescribing: from 41.8% to 34.8% of cough/cold episodes (-7.0%) and from 77.3% to 60.8% of sore throat episodes (-16.4%). These aggregated data conceal wide regional variations. For cough/cold the change in prescribing rate during the study varied from -16.0% to +5.3% and for sore throat from -28.3% to -7.3%.

CONCLUSIONS

In addition to a substantial reduction in diagnosis of cough/cold and sore throat, there has been a reduction in diagnosis-related prescribing episodes in almost all regions. Although there continues to be regional variation in diagnosis-related prescribing this has reduced substantially over the 9-year study period.

MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins?

Histopathological audit of positive circumferential resection margins (CRMs) can be used as a surrogate measure of the success of rectal cancer treatment. We audited CRM involvement in rectal cancer patients and the impact of the multidisciplinary team (MDT) on implementing a magnetic resonance imaging (MRI)-based preoperative treatment strategy. Data were collected on all newly diagnosed rectal cancer patients treated in our network between January 1999 and December 2002. Data were analysed for MRI prediction and histopathological assessment of CRM together with the MDT meeting treatment decisions. The CRM+ve rate of those discussed at MDT vs those not discussed were compared. We re-audited the CRM+ve rates 1 year after introducing a policy of mandatory preoperative MRI-based MDT discussion. Of the 298 patients diagnosed with rectal cancer, 39 (13%) were deemed palliative, 178 underwent surgery alone and 81 underwent neoadjuvant therapy. Of these, 62 out of 178 patients underwent surgery alone without MRI-based MDT discussion resulting in positive CRM in 16 cases (26%) as compared to 1 out of 116 (1%) in those patients with MDT discussion of MRI. Overall CRM+ve rate in all nonpalliative patients with or without MDT discussion was 12.5% (32 out of 256), significantly lower than the <20% rate (P<0.001) quoted in national guidelines. Re-audit in 98 consecutive patients following a change of policy produced a lower CRM+ve rate of 3% (1 out of 37) for all surgery alone patients and an overall CRM+ve rate of 7% (5 out of 70). In conclusion, MDT discussion of MRI and implementation of a preoperative treatment strategy results in significantly reduced positive CRM in rectal cancer patients.

Calcium supplementation does not affect CRP levels in postmenopausal women--a randomized controlled trial

INTRODUCTION

Epidemiological studies suggest that calcium supplementation may decrease the risk of cardiovascular disease.

METHODS

Since the inflammatory marker C-reactive protein (CRP) is a risk factor for cardiovascular disease, and CRP production is potentially responsive to parathyroid hormone, we measured high-sensitivity CRP at baseline and 12 months in a subset of healthy postmenopausal women participating in a randomized controlled trial of the effects of 1 g of calcium daily on the incidence of fractures.

RESULTS

At baseline, we found that CRP correlated positively with indices of body weight and fat and with bone mineral density (BMD) at the total body and total hip sites, but the associations between CRP and BMD were lost after adjustment for body weight. There were consistent associations between levels of CRP and markers of the metabolic syndrome (fat mass, plasma triglycerides, fasting glucose).

CONCLUSION

After 1 year of calcium supplementation, there was no difference between the groups in levels of CRP. We conclude that levels of CRP correlate with anthropometric and biochemical features of insulin resistance, but that they are neither predictive of BMD nor affected by 1 g of calcium supplementation in healthy postmenopausal women.

Beliefs and practices of patients with advanced cancer: implications for communication

The aim of this study was to investigate the beliefs that patients with advanced cancer held about the curability of their cancer, their use of alternatives to conventional medical treatment, and their need to have control over decisions about treatment. Of 149 patients who fulfilled the criteria for participation and completed a self-administered questionnaire, 45 patients (31%) believed their cancer was incurable, 61 (42%) were uncertain and 39 (27%) believed their cancer was curable. The index of need for control over treatment decisions was low in 53 patients (35.6%) and high in only 17 patients (11.4%). Committed users of alternatives to conventional medical treatments were more likely to believe that their cancer was curable (P<0.001) and to have a higher need for control over decisions about treatment (P<0.004). The mean need for control scores were highest in patients who believed that their cancer was curable, or who were uncertain about the curability of their cancer, but who acknowledged that their oncologist had reported that the cancer was incurable. The diverse beliefs, attitudes and actions of these patients were consistent with a range of psychological adaptions to a life-threatening illness, some realistic and others illusory. Illusory responses influence what communication can achieve in daily oncology practice.

Illusions in advanced cancer: The effect of belief systems and attitudes on quality of life

Patients with advanced cancer frequently express positive attitudes and can be unduly optimistic about the potential benefits of treatment. In order to evaluate an illusory domain in the context of advanced cancer, we developed a scale of will to live and characterized the beliefs that patients held about the curability of their cancer, and how committed they were to using alternative treatments. A measure of quality of life was used as the dependent variable in order to assess the association between these attributes. After a preliminary exploration confirmed the presence of an illusory domain, these concepts were prospectively tested in 149 ambulant patients with advanced cancer who attended for palliative systemic treatment, radiation treatment or supportive care. The scale of global quality of life was reliable (Cronbach's alpha coefficient 0.72). The distribution of the scores of will to live was skewed, with no respondent scoring poorly, and the scale was reliable (Cronbach's alpha coefficient 0.82). The scale of belief in curability showed diverse beliefs. In some cases, there was a discrepancy between respondents' beliefs in curability and what they believed to be the report by their doctors. There was also an association between a committed use of alternative treatments and a belief in the curability of the cancer (p<0.001). In a multiple regression analysis, both will to live and performance status remained associated with better quality of life scores after adjustment for other relevant variables (p<0.05 and <0.001, respectively). These results suggest that positive illusory beliefs can be measured and are an important component of adaption for some patients with advanced cancer. Furthermore, this illusory domain may influence the perception and measurement of quality of life.

CDP840. A prototype of a novel class of orally active anti-inflammatory phosphodiesterase 4 inhibitors

The discovery, synthesis and biological activity of a series of triarylethane phosphodiesterase 4 inhibitors is described. Structure-activity relationship studies are presented for CDP840 (29), a potent, chiral, selective inhibitor of PDE 4 (IC(50) 4nM). CDP840 is non-emetic in the ferret at 30mgkg(-1) (po), active in models of inflammation and reverses ozone-induced bronchial hyperreactivity in the guinea pig.